Resolution Millenium medical aid plan: 2017

Pay for all children.

View all plans in this scheme

IN HOSPITAL PROCEDURES:
Payout Rate for Specialists:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:
Hospital Choice:
  • Unlimited
Specialised Radiology:
  • R15,003 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
Transplants:
  • Unlimited
Co-payments:
  • Excision nail bed, skin lesions:R1,881 co-payment
  • Dental admissions, circumcision, colonoscopy, sigmoidoscopy, proctoscopy, cystoscopy, gastroscopy: R2,504 co-payment
  • Hysteroscopy: R2,816 co-payment
  • Arthroscopy, endometrial ablation, laparoscopic procedures, urinary incontinence repair, varicose veins, conservative back, spinal treatment, hernia repair, hysterectomy: R3,751 co-payment
  • Nasal surgery: R5,632 co-payment
  • Joint replacements, rotator cuff surgery: R7,157 co-payment
  • Spinal surgery: R7,824 co-payment
  • Reflux surgery: R10,752 co-payment
Alternatives to hospitals:
  • Home nursing: 10 days per family
  • Hospice, rehab and step down facility: 18 days per family

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OUT OF HOSPITAL BENEFITS:
GP consultations:
  • Paid from day-to-day benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

Specialists consultations:
  • Paid from day-to-day benefit
Pathology:
  • Paid from day-to-day benefit
General radiology:
  • Paid from day-to-day benefit
Specialised radiology:
  • R15,003 per family with R1,892 co-payment. In and out of hospital
Supplementary Services: (Physio, etc)
  • Paid from day-to-day benefit

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MATERNITY BENEFITS:
Hospital stay:
  • Vaginal birth: 3 days, 2 nights
  • Caesarean birth: 4 days, 3 nights
  • Elective Caesarean: no benefit
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

Consultations:
  • 9 consults, from day-to-day benefit
  • Antenatal classes: from day-to-day benefit
  • Baby care products: R813 at DSP
Scans:
  • 2 x 2D scans, paid by scheme

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CANCER (ONCOLOGY):
Overall coverage (in and out of hospital):
  • Unlimited subject to DSP

Note: All oncology benefits are assessed on a case-by-case basis, and are subject to protocols, preferred providers and scheme rules. Benefit covers out-of-hospital treatment too, like chemotherapy.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

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DENTISTRY:
Dentistry: Standard dentistry:
  • Paid from day-to-day benefit, subject to sub limits below
MainAdultChild
R5,899R8,137R9,673
Advanced dentistry:
  • Paid from day-to-day benefit, subject to sub limits below
  • Implants and periodontics: no benefit
MainAdultChild
R5,899R8,137R9,673
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

Orthodontics:
  • Paid from day-to-day benefit
Maxillo Facial Surgery:

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MEDICATION:
Chronic:
  • PMB chronic: paid by scheme
  • non-PMBs: Additional 10 conditions covered
  • M= R2,649 and M+= R5,310. Thereafter, only PMBs covered.
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:
Acute (presrcibed) medication:
  • Paid from day-to-day benefit, subject to sub limits below
MM1M2+
R5,899R8,137R9,673
Over-the-counter:
  • Shared with acute medicine limit, subject to sub limits below
MM1M2+
R1,748R2,438R2,872
Birth Control:
  • R1,496 per female, from preventative benefit limit
On Discharge:
  • 7 days supply
Notes:
  • Chronic meds: Must be obtained from DSP. Formularies apply. Reference and GRP pricing apply

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OPTOMETRY:
Optometry:
  • R2,649 per person, subject to day-to-day benefit
  • Every 2 years
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

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MENTAL HEALTH:
In-hospital:
  • R18,755 per family
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:


Out-of-hospital:
  • Paid from day-to-day benefit

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OTHER BENEFITS:
General Appliances:
  • R11,252, with sub limits
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

1.1. Hearing Aids: See above
1.2. Wheelchairs: See above
Dialysis:
  • PMBs only, at network providers
HIV:
  • Covered at network hospitals if on HIV Management Programme
Emergency Transport: Netcare 911
International Coverage:
  • R2 million per person per emergency incident
Other:
  • Cochlear implants: R75,016 per family

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WELLNESS/PREVENTATIVE BENEFITS:
Flu vaccination:
  • Covered subject to overall R2,493 per family for preventative care benefits
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:

Pneumonia vaccines:
Back Rehabilitation Programme:
Biometric Screening:
  • Covered subject to overall R2,493 per family for preventative care benefits
Child Immunisation:
  • R1,875 subject to overall R2,493 per family for preventative care benefits
Pap Smear:
  • Covered subject to overall R2,493 per family for preventative care benefits
Mammogram:
  • Covered subject to overall R2,493 per family for preventative care benefits
PAS Test:
  • Covered subject to overall R2,493 per family for preventative care benefits
HIV Test:
  • Covered subject to overall R2,493 per family for preventative care benefits

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PROSTHESIS:
Overal Limit:
Overall Annual Limit (OAL):
Unlimited overall, with sub-limits
Contributions:
Main: Adult: Child:
Total Cost: R4,200 R3,598 R979
Children: Pay for all children
Day-to-Day Benefit:
Main: Adult: Child:
(S) Savings: R10,092 R8,628 R2,340
(SP) Self Payment: R3,479 R2,629 R633
Threshold (S+SP): R13,571 R11,257 R2,973
Above Threshold: 5,544 4,728 774

Compare with these plans:
Sub-limits:

    Important!
  • Unless specified, assume that all benefits are paid are paid at 100% scheme rate
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • “Unlimited” benefits are still subject to authorisation, protocols and sublimits
  • Assume that all benefits need to be pre-authorised